Yes, some types of vestibular disorders are less responsive to vestibular rehabilitation than others.
The principle of vestibular rehabilitation is to decrease symptoms by training the brain to optimize the use of the inner-ear input and to integrate that input effectively with the visual and proprioceptive information. Sudden changes in inner ear function can produce severe symptoms of vertigo and vomiting but once the inner ear function stabilizes, the brain can be trained to readjust to it.
However, if the nature of the vestibular disorder is to fluctuate or to deteriorate progressively, it can be extremely challenging for the brain to adjust to these repetitive changes. Individuals suffering from Ménière’s disease, for example, are not good candidates for vestibular rehabilitation when they are going through active stages of the disorder in which spells are happening often. Patients with recurrent types of vestibular disorders often benefit more from medical management of the attacks than from vestibular rehabilitation.
One vestibular disorder that does not classically fluctuate but also does not respond well to vestibular rehabilitation is semicircular canal dehiscence (SCD). In cases not treated surgically, avoidance of triggers remains the best management strategy; for example, patients should avoid exposure to loud sounds that can trigger dizziness or imbalance.
Even if vestibular rehabilitation exercises don’t help you, vestibular therapists may be able to educate you on ways to manage your condition or symptoms. Examples include learning how to pace activity, using mobility aids such as a walker or cane, or even just moving more slowly and not doing quick movements that might make you feel dizzy or off balance. A therapist may also work with your on improving your strength and balance to either avoid losing your balance or, if possible, better controlling the force of a fall to minimize injury.